In The Wall Street Journal, Clayton Christensen, Jeffrey Flier and Vineeta Vijayaraghavan say that the Affordable Care Act's updated versions of HMOs are based on flawed assumptions about doctor and patient behavior.
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Bringing into focus a clear and distinct view of the rest of this decade in Texas health care. Offering a sharp perception of what lies ahead and what we must change to keep us all healthy.
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Texas Medical Association
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Scooped by Texas Medical Association onto Healthy Vision 2020 |
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Modifications to HIPAA may take the focus off patients and pile on administrative work.
Texas Medical Association's insight:
Eliminate costs and hassles that don’t contribute to or add value to patient care
New compliance requirements are bombarding physician practices seemingly every day. Just in January 2012, a new electronic format for claims and other electronic transactions (called “HIPAA 5010”) added new costs to physician practices. The switch to the International Classification of Diseases and Related Health Problems version 10 (ICD-10), currently set for October 2014, will require the adoption of an entirely new coding system to record all possible diagnoses and inpatient procedures. It will add significant physician and staff training costs.
Medicare’s required new PQRS provides a monetary incentive at first but imposes penalties beginning in 2015. A number of new state and federal privacy laws introduce more administrative burden, and severe new penalties for noncompliance. State and federal governments are using more “fraud” detection, resulting in monumental compliance programs that further increase the cost of running a practice. TMA and dozens of other medical societies have written to CMS “about the imminent storm that is about to occur due to simultaneous implementation of multiple programs that will create extraordinary financial and administrative burden, as well as mass confusion, for physicians.” These changes have limited documented evidence they will lower fraud or improve privacy, but complete assurance they will increase the cost of doing business in medicine.
It’s because of the vast number of complex commercial insurance and federal and state regulations that affect physicians and their patients that TMA developed the Calendar of Doom.
The cost to operate a physician’s office continues to climb unabated. Unfunded mandates and hidden regulatory burdens like the ongoing hassles of annually renewing state registration to continue to prescribe needed medications for patients threaten the viability of practices and patients’ access to care. The average cost to staff and run a practice now exceeds $500,000 per physician, and that’s before the physician gets paid a dime. These excessive administrative expenses add to the escalating cost of medical care that are borne by patients, employers, and taxpayers.
Excessive regulations also hurt local economies, which receive nearly $1 million in wages and benefits for each physician in practice. Physician offices employ support staff and often work with nonphysician providers, increasing the total number of employees in the industry to well above the count of physicians alone. In 2009, Texas office-based physicians supported 249,010 jobs. On average, each office-based physician supported 5.8 jobs, including his or her own.
Texas should not burden practices with additional regulatory costs that provide no benefit to patients or their health care. Delete the scoop?
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Defend physicians’ ethical responsibilities to patients
It will be more and more challenging for physicians to maintain professional ethics when ethics collide with economic interests.
Our evolving health care system structure is constantly emphasizing lowering costs. So-called “quality-based measures” may give physicians perverse incentives to dismiss patients who do not meet target measures, and they may be asked to ration health care resources in ways that place employers’ or Wall Street’s needs above those of the individual patient’s.
Furthermore, hospitals and other entities will continue to look toward employing physicians so they can consolidate market share and capture the payment stream for physician services. Physicians who accept employment opportunities with hospitals and other practice models not owned and controlled by physicians could find their clinical autonomy threatened.
The ability of physicians to act in their patients’ best interests must not be compromised by outside — and sometimes competing — economic, political, or social pressures. Yet lawmakers and other nonphysicians are ever more inclined to delineate the details of the interaction between physicians and patients. Physicians increasingly face nonphysicians’ attempts to mandate what information, tests, procedures, and treatments they must — or must not — provide to their patients.
The practice of medicine is founded upon ethics that arise from the imperative to alleviate suffering and to care for patients. According to the AMA Code of Medical Ethics, “The relationship between patient and physician is based on trust and gives rise to physicians’ ethical obligations to place patients’ welfare above their own self-interest and above obligations to other groups, and to advocate for their patients’ welfare.”